S E MacNeill1, P A Lichtenberg. 1. Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA.
Abstract
OBJECTIVE: Evaluation of the utility of a "decision tree" that identifies potential mental health problems in older medical patients and guides decision making for referrals. DESIGN: Measures of utility including sensitivity, specificity, and predictive power were examined. Independent t tests and nonparametric statistics were used to evaluate group differences where appropriate. SETTING: The stroke and geriatric unit of a freestanding urban medical rehabilitation hospital. SUBJECTS: In study 1,173 older, consecutively admitted medical rehabilitation patients completed all cognitive measures. In study 2, a separate sample of 313 older adults completed the Geriatric Depression Scale during admission. MAIN OUTCOME MEASURE: The MacNeill-Lichtenberg Decision Tree (MLDT) was compared with the Mini-Mental State Exam (MMSE), the Mattis Dementia Rating Scale, and the 30-item Geriatric Depression Scale. RESULTS: Study 1: The decision tree accurately triaged 87% of mental health problems and allowed for deferral of 41% of cases, for whom further assessment was unnecessary. The MLDT was superior to the MMSE, with higher sensitivity and a lower failure rate. Study 2: The emotional status component of the MLDT was useful in triaging cases for depression evaluation. CONCLUSION: The MLDT was useful in prioritizing cases with regard to mental health problems (eg, dementia, depression) and making quick referral decisions. The MLDT is a unique instrument that not only evaluates cognitive status, but also considers psychosocial factors and emotional status in older adults.
OBJECTIVE: Evaluation of the utility of a "decision tree" that identifies potential mental health problems in older medical patients and guides decision making for referrals. DESIGN: Measures of utility including sensitivity, specificity, and predictive power were examined. Independent t tests and nonparametric statistics were used to evaluate group differences where appropriate. SETTING: The stroke and geriatric unit of a freestanding urban medical rehabilitation hospital. SUBJECTS: In study 1,173 older, consecutively admitted medical rehabilitation patients completed all cognitive measures. In study 2, a separate sample of 313 older adults completed the Geriatric Depression Scale during admission. MAIN OUTCOME MEASURE: The MacNeill-Lichtenberg Decision Tree (MLDT) was compared with the Mini-Mental State Exam (MMSE), the Mattis Dementia Rating Scale, and the 30-item Geriatric Depression Scale. RESULTS: Study 1: The decision tree accurately triaged 87% of mental health problems and allowed for deferral of 41% of cases, for whom further assessment was unnecessary. The MLDT was superior to the MMSE, with higher sensitivity and a lower failure rate. Study 2: The emotional status component of the MLDT was useful in triaging cases for depression evaluation. CONCLUSION: The MLDT was useful in prioritizing cases with regard to mental health problems (eg, dementia, depression) and making quick referral decisions. The MLDT is a unique instrument that not only evaluates cognitive status, but also considers psychosocial factors and emotional status in older adults.
Authors: Sam T Creavin; Susanna Wisniewski; Anna H Noel-Storr; Clare M Trevelyan; Thomas Hampton; Dane Rayment; Victoria M Thom; Kirsty J E Nash; Hosam Elhamoui; Rowena Milligan; Anish S Patel; Demitra V Tsivos; Tracey Wing; Emma Phillips; Sophie M Kellman; Hannah L Shackleton; Georgina F Singleton; Bethany E Neale; Martha E Watton; Sarah Cullum Journal: Cochrane Database Syst Rev Date: 2016-01-13
Authors: Anne Dull Baird; Susanne Wickie; Susan MacNeill; Sara R Friedman; Julia Fitzgerald Smith Journal: Neuropsychiatr Dis Treat Date: 2006-03 Impact factor: 2.570